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Kanokrungsee S, Likittanasombat S, Chaweekulrat P, Kumpangsin T, Boonchai W. Prevalence and causative allergens of contact cheilitis in Thailand. Contact Dermatitis 2023; 89:345-351. [PMID: 37607557 DOI: 10.1111/cod.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Cheilitis is an inflammatory condition of the lips. Its causes can be exogenous (irritants, allergens), endogenous (atopic dermatitis, systemic disorders) or unknown. OBJECTIVES To determine the prevalence of allergic contact cheilitis (ACC), its risk factors, and common allergens in patients with cheilitis at a Thai university-based tertiary care hospital. METHODS A retrospective chart review was conducted on patients with cheilitis referred for patch testing between January 2007 and December 2021. RESULTS Among 5366 patients referred for patch testing, 410 (7.6%) had cheilitis. ACC was diagnosed in 32% of the cheilitis patients. Compared to non-ACC cases, the patients with ACC were more likely to be young and female and have a disease duration of <3 months, no underlying disease and a white-collar job (p-value <0.05). The most common contact allergens were patient's products (73.3%), nickel sulfate (29.8%), potassium dichromate (14.5%), castor oil (14.3%) and benzalkonium chloride (13.0%). Lip cosmetics and toothpastes were major ACC sources. CONCLUSIONS ACC should be considered in cheilitis patients, especially in patients with specific risk factors. Castor oil is an emerging allergen. Patch testing using commercial allergen series and patients' own products is crucial for identifying causative agents. The development of a specific cheilitis series is warranted.
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Affiliation(s)
- Silada Kanokrungsee
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pichanee Chaweekulrat
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Titinun Kumpangsin
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waranya Boonchai
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Silverberg JI, Chaubal M, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Houle MC. Prevalence and trend of allergen sensitization in patients with cheilitis referred for patch testing, North American Contact Dermatitis Group data, 2001-2018. Contact Dermatitis 2023; 88:300-314. [PMID: 36502370 DOI: 10.1111/cod.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/20/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND An updated understanding of allergic contact cheilitis is needed. OBJECTIVES To characterize clinical characteristics and allergen relevance in patients with cheilitis referred for patch testing. METHODS Retrospective analysis of 43 772 patients patch tested with the North American Contact Dermatitis Group (NACDG) screening series from 2001 to 2018. RESULTS Overall, 2094 patients (4.8%) had lips as one of three sites of dermatitis, 1583 (3.6%) had lips as the primary site and 1167 (2.7%) had lips as the sole site of dermatitis. Prevalences of cheilitis at any, primary, and sole sites significantly increased throughout the study cycle from 2001-2002 (2.7%, 2.2% and 1.7%) to 2017-2018 (7.8%, 5.2% and 3.7%). Approximately 60% of patients with any, a primary, or a sole site of cheilitis had one or more positive allergic patch-test reactions compared to 65% of those without cheilitis. CONCLUSION Patients with cheilitis who were referred for patch testing had high rates of positive and relevant allergens. More than one in four patients with any, primary, or sole cheilitis had a positive reaction to non-NACDG screening allergens (28.0%, 26.8%, 31.1% vs. 21.6%) compared to patients without cheilitis, emphasizing the need for expanded patch test series in cheilitis.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Manotri Chaubal
- Department of Dermatology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Quebec City, Quebec, Canada
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Melchers RC, Quint KD, van Zuuren EJ. Contact allergy to a shellac containing mouthguard. Contact Dermatitis 2022; 86:554-556. [PMID: 35188994 PMCID: PMC9311161 DOI: 10.1111/cod.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rutger C Melchers
- Department of Dermatology, Leiden University Medical Center, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, The Netherlands
| | - Esther J van Zuuren
- Department of Dermatology, Leiden University Medical Center, The Netherlands
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Zhou LL, Pratt M. Allergic Contact Cheilitis From a Variety of Lip Balm Ingredients. J Cutan Med Surg 2017; 22:333-335. [PMID: 29039219 DOI: 10.1177/1203475417738969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Melanie Pratt
- 2 Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
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Nyman G, Hagvall L. A case of allergic contact cheilitis caused by propolis and honey. Contact Dermatitis 2016; 74:186-7. [PMID: 26899810 DOI: 10.1111/cod.12500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/04/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Gunnar Nyman
- Hudläkarmottagningen Telegrafen, 50330, Borås, Sweden
| | - Lina Hagvall
- Dermatology Department, Sahlgrenska University Hospital, 41345, Göteborg, Sweden
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Van Baelen A, Kerre S, Goossens A. Allergic contact cheilitis and hand dermatitis caused by a toothpaste. Contact Dermatitis 2016; 74:187-9. [DOI: 10.1111/cod.12505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Anne Van Baelen
- Department of Dermatology; University Hospitals, K.U. Leuven; B-3000 Leuven Belgium
| | - Stefan Kerre
- Department of Dermatology; University Hospitals, K.U. Leuven; B-3000 Leuven Belgium
- Private Dermatology Practice; B-1200 Aarschot Belgium
| | - An Goossens
- Department of Dermatology; University Hospitals, K.U. Leuven; B-3000 Leuven Belgium
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Abstract
The whole examination of oral cavity, other mucosae and skin is required when managing a cheilitis. Irritants (climatic, mechanical, caustic agents...) constitute the main aetiological factors of cheilitis. Allergic contact cheilitis should be investigated with a detailed anamnesis in order to search any causative agent in contact with the oral mucosae. Patch testing is required to confirm the diagnosis of delayed hypersensivity. Chronic actinic cheilitis occurs mostly in middle-aged, fair-skinned men. It is a potentially malignant condition that requires biopsies to exclude severe dysplasia or carcinoma. Angular cheilitis can occur spontaneously but is frequently related with several precipitating factors, such as systemic immune suppression, local irritation and moisture, fungal and/or bacterial infection. Cheilitis can also be seen in various systemic conditions such as lichen planus, lupus, atopic dermatitis and nutritional deficiencies. Erosive and crusty cheilitis and bullous erosive stomatitis are the main oral features of erythema multiforme and Stevens-Johnson syndrome. Granulomatous macrocheilitis (cheilitis granulomatosa) presents with intermittent or permanent lip swelling. It should be confirmed by a biopsy. It can be either isolated (Miescher macrocheilitis) or associated with various systemic conditions.
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Affiliation(s)
- Mahtab Samimi
- CHU de Tours, université François-Rabelais, service de dermatologie, 37044 Tours, France; ISP 1282, Inra, université de Tours, 37200 Tours, France.
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Affiliation(s)
- Jae In Lee
- Department of Dermatology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lavy Y, Slodownik D, Trattner A, Ingber A. Toothpaste Allergy as a Cause of Cheilitis in Israeli Patients. Dermatitis 2009. [DOI: 10.2310/6620.2009.08058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Katsarou A, Armenaka M, Vosynioti V, Lagogianni E, Stavropoulos PG, Kalogeromitros D. Allergic contact cheilitis in Athens. Contact Dermatitis 2008; 59:123-5. [DOI: 10.1111/j.1600-0536.2008.01342.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- E C Veysey
- Department of Dermatology, Churchill Hospital, Old Road, Headington, Oxford, Oxon, UK.
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Abstract
A recent epidemiologic survey in the UK revealed that 23% of women and 13.8% of men experience some sort of adverse reaction to a personal care product over the course of a year. Although most of these reactions may be due to subjective sensory irritation, various studies reveal that up to 10% of dermatologic patients who are patch tested are allergic to cosmetic products or their constituent ingredients. Causative products include deodorants and perfumes, skin care products, hair care products, and nail cosmetics. Allergic contact dermatitis mainly results from fragrance chemicals and preservatives. Recent work has suggested that additional fragrance chemicals may need to be tested in order to identify those patients 'missed' by the current fragrance mix; in particular, hydroxy-isohexyl-3-cyclohexene carboxaldehyde (HMPPC Lyral) has been singled out as an important sensitizing agent. The increased usage of natural fragrances and botanic extracts can also cause problems in their own right or through co-reactivity. The preservative methyldibromo glutaronitrile has also been recognized as an increasingly important sensitizer in Europe, which has led to the recent recommendation that it should be prohibited from 'leave-on' products until information on 'safe' consumer levels becomes available. Other emerging allergens include UV filters, tosylamide/formaldehyde resin, and nail acrylates. The diagnosis of cosmetic allergy should be confirmed with patch testing, including testing of 'whole' products, when necessary, and repeat open application tests can be used to confirm the relevance of reactions in cases of doubt.
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Affiliation(s)
- David I Orton
- Environmental and Contact Dermatitis Unit, Department of Dermatology, Amersham Hospital, Amersham, Buckinghamshire, UK
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Affiliation(s)
- Monica Corazza
- Department of Clinical and Experimental Medicine--Section of Dermatology, University of Ferrara, Ferrara, Italy.
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Affiliation(s)
- D I Orton
- Dermatology Department, Amersham Hospital, Amersham, Buckinghamshire HP7 0JD, UK
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Abstract
Throughout the centuries, the beauty of lips has been extolled by poets, and painters; and people in many different cultures decorate their lips. Modern cosmetics are designed not only to beautify the lips but also to moisturize and protect them from environmental hazards. Familiarity with the ingredients used in lip cosmetics is essential to recognizing and diagnosing the adverse reactions that are associated with these products.
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Affiliation(s)
- P G Engasser
- Department of Dermatology, Stanford University School of Medicine, California, USA.
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Le Coz CJ, Bezard M. Allergic contact cheilitis due to effervescent dental cleanser: combined responsibilities of the allergen persulfate and prosthesis porosity. Contact Dermatitis 1999; 41:268-71. [PMID: 10554061 DOI: 10.1111/j.1600-0536.1999.tb06159.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 55-year-old man with a dental prosthesis for 3 years had had a chronic relapsing cheilitis for more than 1 year. He was patch tested with the European standard series, his own topicals, and the dental cleanser at 10% pet. A relevant positive reaction ++ was found to the cleansing agent, which contained 20% potassium persulfate. The breakdown of the test confirmed sensitivity to this agent and to ammonium persulfate, both positive (++) at 2.5% pet. The patient was free of symptoms after he had avoided the cleanser. Subsequent chemical investigations performed with a fragment of a used dental prosthesis revealed strong adsorption of persulfate, both on the resin and on the dental tartar. Cleansing agents, adsorbed on tartar and porous resins of worn dental prostheses, should be considered as potential sensitizers and consequently patch tested on such patients with chronic cheilitis.
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Affiliation(s)
- C J Le Coz
- Consultation de Dermato-Allergologie, Clinique Dermatologique des Hôpitaux Universitaires de Strasbourg 1, France
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Affiliation(s)
- S J Beswick
- Department of Dermatology, Central Outpatients, North Staffordshire Hospital, Stoke-on-Trent, UK
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Abstract
Signs and symptoms of contact allergic reactions affecting the oral mucosa may mimic other common oral disorders, making diagnosis difficult. Patients frequently seek multiple consultations and do not receive the correct diagnosis or effective management. As intraoral contact allergy may be more prevalent than previously believed, a review of this topic is warranted. This article emphasizes signs and symptoms that suggest intraoral contact allergy, and the authors discuss the allergens that most frequently affect the oral mucosa.
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Affiliation(s)
- S S De Rossi
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, Philadelphia 19104, USA
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Affiliation(s)
- C L Goh
- National Skin Centre, Institute of Dermatology, Singapore
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Affiliation(s)
- A C De Groot
- Department of Dermatology, Carolus-Liduina Hospital, 's-Hertogenbosch, Netherlands
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Affiliation(s)
- Y C Chang
- Department of Dermatology, School of Medicine, University of California, San Francisco 94143-0989, USA
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Lewis FM, Shah M, Gawkrodger DJ. Contact sensitivity to food additives can cause oral and perioral symptoms. Contact Dermatitis 1995; 33:429-30. [PMID: 8706405 DOI: 10.1111/j.1600-0536.1995.tb02082.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- F M Lewis
- University Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK
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